Endocrinol Metab.  2020 Dec;35(4):960-964. 10.3803/EnM.2020.732.

Establishment of Reference Intervals for Serum Insulin-Like Growth Factor I in Korean Adult Population

• Kim B
• Cho Y
• Ku CR
• Lee SG
• Lee KA
• Kim JH

• KMID: 2511024
• DOI: http://doi.org/10.3803/EnM.2020.732

Abstract

Appropriate reference intervals of serum insulin-like growth factor I (IGF-I) is important for diagnosing and monitoring patients with growth hormone-related diseases. To establish reference intervals, adult individuals (n=1,334, 680 men and 654 women) were divided into six age groups (20–29, 30–39, 40–49, 50–59, 60–69, ≥70). Serum IGF-I was measured by chemiluminescence immunoassay (Liaison). Concordance of patient classification based on reference intervals, manufacturer’s intervals, and standard deviation score (SDS) was evaluated. New reference intervals had higher upper and lower limits than those specified by the manufacturer. The agreement between classification using new reference interval and the manufacturer’s reference interval, and that using new reference interval and SDS was 75.0% (weighted kappa, 0.17), 91.9% (weighted kappa, 0.51) in men and 91.0% (weighted kappa, 0.41), 92.5% (weighted kappa, 0.53) in women, respectively. Reference intervals should be established not only based on age and sex, but also on ethnicity and assay method.

Keyword

Insulin-like growth factor I; Reference values; Luminescent measurements

Figure

• 

  Fig. 1 Individual data and comparison between the new reference intervals and reference intervals of Liaison insert. The black points indicate individual data. New reference intervals are shown in colored section (A: blue, men; B: red, women). Reference intervals of Liaison insert paper are shown in the grey section. Liaison insert paper only showed reference intervals until the age of 85 years. IGF-I, insulin-like growth factor I.

Reference

1. Mavromati M, Kuhn E, Agostini H, Brailly-Tabard S, Massart C, Piketty ML, et al. Classification of patients with GH disorders may vary according to the IGF-I assay. J Clin Endocrinol Metab. 2017; 102:2844–52.

2. Dogansen SC, Yalin GY, Tanrikulu S, Yarman S. Impact of glucose metabolism disorders on IGF-1 levels in patients with acromegaly. Horm Metab Res. 2018; 50:408–13.

3. Hyun SE, Lee BC, Suh BK, Chung SC, Ko CW, Kim HS, et al. Reference values for serum levels of insulin-like growth factor-I and insulin-like growth factor binding protein-3 in Korean children and adolescents. Clin Biochem. 2012; 45:16–21.

4. Choi HK, Kong MH, Ahn BH, Kim SM, Lee DJ, Kim KM. Insulin-like growth factor 1 level and its relating factor in Korean healthy adults. Korean J Fam Med. 2009; 30:15–22.

5. Zhu H, Xu Y, Gong F, Shan G, Yang H, Xu K, et al. Reference ranges for serum insulin-like growth factor I (IGF-I) in healthy Chinese adults. PLoS One. 2017; 12:e0185561.

6. Clinical and Laboratory Standards Institute. Defining, establishing, and verifying reference intervals in the clinical laboratory; approved guideline. 3rd ed. Wayne: Clinical and Laboratory Standards Institute;2008.

7. Tukey JW. Exploratory data analysis. Reading: Addison-Wesley Pub;1977.

8. Solberg HE. Approved recommendation (1987) on the theory of reference values. Part 5. Statistical treatment of collected reference values. Determination of reference limits. Clin Chim Acta. 1987; 170:S13–32.

9. Chanson P, Arnoux A, Mavromati M, Brailly-Tabard S, Massart C, Young J, et al. Reference values for IGF-I serum concentrations: comparison of six immunoassays. J Clin Endocrinol Metab. 2016; 101:3450–8.

10. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977; 33:159–74.

11. Clemmons DR. Consensus statement on the standardization and evaluation of growth hormone and insulin-like growth factor assays. Clin Chem. 2011; 57:555–9.

12. Gayan-Ramirez G, Vanderhoydonc F, Verhoeven G, Decramer M. Acute treatment with corticosteroids decreases IGF-1 and IGF-2 expression in the rat diaphragm and gastrocnemius. Am J Respir Crit Care Med. 1999; 159:283–9.

13. Prummel MF, Wiersinga WM, Oosting H, Endert E. The effect of long-term prednisone treatment on growth hormone and insulin-like growth factor-1. J Endocrinol Invest. 1996; 19:620–3.

14. Clemmons DR. Value of insulin-like growth factor system markers in the assessment of growth hormone status. Endocrinol Metab Clin North Am. 2007; 36:109–29.

15. Teppala S, Shankar A. Association between serum IGF-1 and diabetes among U.S. adults. Diabetes Care. 2010; 33:2257–9.